Screening
for Developmental and Behavioral Disabilities Is Cost-Effective When
Parents Fill Out Standardized Forms

Question

Is it cost-effective to formally screen
for developmental and behavioral disabilities in a primary care clinic?

Clinical
Bottom Lines

Using
conventional interviewing techniques, pediatricians only detect
~50% of children with developmental and behavioral disabilities.

Effective interventions are available. However, the specifics
of interventional strategies (e.g. age, techniques, etc.) are
still being debated.

Use of the Ages & Stages Questionnaire (5-10 min) and either
the Eyberg Child Behavioral Inventory or the Pediatric Symptom
Checklist should enable clinicians to cost-effectively detect
>80% of children with disabilities.

Addressing some issues "in-house" (e.g. ADHD, anxiety,
depression) reduces the number of referrals.

Summary of Key Evidence

Prevalence
12 - 16% of American children have developmental or behavioral
disorders.1
11 - 20% of school-age children could have clinically significant
behavior problems.2

Detection
Pediatricians detect only ~50% of children with developmental
or behavioral disabilities.3
In one study, over 90% of referred patients have a diagnosed developmental
disability.4

Intervention
Disabled persons with high-school diplomas are 40% more likely
to be employed, go on to further training, and earn higher wages.5
Early, intense, and sustained intervention produce the greatest
and most sustained benefits. Early non-intense intervention does
not yield significant long-term benefit.6
Indirect intervention (i.e. training the parents) does not appear
to affect long-term outcome.6

Screening
Screening tools are available that can be photocopied and filled
out by the parents.
Sensitivity and specificity of these tests are generally >80%
and >70%, respectively.
Using formal screening tools may increase detection by 60%. This
may come at the price of increasing the number of referrals to
state agencies.